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Questions for first neurology appointment?

Having been following Pauline's thread in the general section about Dylan, I have been wondering if someone knowledgeable could post a list of important questions that we average pet owners could ask.

Tilly is now 17 months old and has had her MRI. We have a neurology appointment next thursday. She has herniation of the cerebellum and fairly extensive syrinxes from C1-C6. She is symptomatic, scratching frequently now and yelping at many different things.

She is currently on no medication

I would just rather come away from the appointment without the after thoughts of " I wish I had asked about......"

I am also glad I had the foresight when the MRI was done to ask for a copy as the vet hospital that MRI'd her seems to have forgotton to send a copy to my own vet *grrr*

You can get a copy. Phone them and tell them it's imperative you have a copy for the neurologist and don't take "no" for an answer. You paid for the MRI-either cash or paying for the insurance-and you have rights re: the report. Others will have much to tell you but I do think if you can video your little's ones behavior that is a tremendous help for diagnosis and treatment.

Sometimes it takes a long while for them to send on a copy of the scan to you or the vet though it shouldn't. Generally I do not think most neurologists send scans to vets though (maybe I am wrong here but mine didn't get copies) -- and vets are not trained to read MRIs and most of it is going to be meaningless for them anyway. Some neurologists give a sample of shots from the scan on xray sheets and some give a full CD of images, but these go to the owner. Vets also generally should not be prescribing anything except in consultation with the neurologist so again, it isn't like they look at the scan themselves and make decisions -- same as your GP wouldn't prescribe for a specialist problem.

I'd be wondering why they did the scan and no one at that time prescribed something though? Even at the low cost clinics I was given a prescription and some starter medication (frusemide) immediately after they went thru the scan with me.

As for questions I'd want a prognosis as best they can give it; what do they see in dogs this age as far as progression goes, with this type of scan. Are the syrinxes long and skinny and small, or wide? Long and skinny are less damaging than wide but if you are having symptoms that is definitely a concern. Ask about options between surgery and medications and to be blunt -- how long and what quality of life she is likely to have in choosing one or the other (as early onset symptomatic cases tend to have the worst prognosis -- you need an honest answer as much evidence does indicate the earlier surgery is done the better the outcome). I'd ask if they think symptoms are due to herniation or the syrinxes. I'd want a figure for the cost of surgery and the cost of medications (surgery can seem expensive but neurontin and some other drugs are not cheap in the UK/Ireland).

I'd send a registered letter to the breeder informing them of the diagnosis so it is officially recorded and send the relevant information to Sarah Blott as well.

Glancing through my SM website may prompt some other questions that are of interest to you. In particular maybe read through Clare Rusbridge's document. Maybe listen to her podcast on the site as well as that too is good for general understanding and also might raise some questions for you. I'd [print out her treatment diagram so that you can have the names and options for drugs before you.

Think of the neurologist as 1/3 of a three way partnership [neuro, vet, you] in managing Tilly's lifelong, progressive illness. You're going to want to establish how often Tilly will need to be seen by the neuro, whether the neuro will work with your vet for managing her medications, and how the neuro will respond to any emergencies if they should arise.

When Charlie was alive, our neurologist worked in a full service animal hospital, so I could call anytime of the day or night, and on weekends and holidays if we had an emergency. And while on the topic of emergencies, fnd out what the neuro considers to be an emergency - if my dog is in pain and the meds aren't working, it is an emergency to me. We also had an arrangement with our neuro and regular vet, where the neuro would call in additional pain meds for Charlie to our regular vet, saving us a 2 hour trip.

Also, and this is really important, if you are on a tight budget and the neurologist prescribes very expensive, complex, or out of the ordinary medications that have to be filled at a special compounding pharmacist - ask if they can work with you to prescribe more affordable medicines. [The exception to this would be if your dog is having decompression surgery!!!] I'll give you an example - Charlie needed 80 mg Gabapentin, which was very expensive to have filled at a compounding pharmacist. Geordie gets 100mg Gabapentin which costs $4.00 a month at our supermarket pharmacy for humans!!!

Think in terms of all the questions you would ask your pediatrician if you had a newborn baby with a serious illness.